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Perpetual Student

Perpetual Student

PACU
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Perpetual Student has 4+ years experience and specializes in PACU.

I'm running out of time!

Perpetual Student's Latest Activity

  1. Perpetual Student

    I just started a new job and have pneumonia. Very worried...

    As stated, they could terminate you if they so desired. It sounds like honestly they need nurses, and you sound like a motivated employee who happened to get really sick, so I doubt they will terminate you. By the time they terminated you and trained somebody else you would probably be ready to return, so it'd defeat the purpose assuming you're an otherwise good employee. I hope you get well soon and are able to jump back into your new job once you're healthy.
  2. Perpetual Student

    Nurses: How Do You Feel About Your Patients Being Nurses?

    As a patient, I try to be extra accommodating and non-demanding. I will quietly voice any requests, but make it clear that I think it's a kindness for someone to do anything other than keep me from dying and that I have no problem waiting until it's a decent time. I make it clear that I value input and thank people. That's not to say that I don't ask questions or want anything, but I try to be super respectful just as I'd want someone to treat me or my colleagues. Fortunately I've yet to encounter a nurse or provider in my own care whose competence I was concerned about. If I did . . . well, I'd still try to be polite about it. One thing I've learned from doing this job (and my mommy may she RIP), is that a smile and a thank you are a lot more effective than being rude or obnoxious. Honestly, I'd rather be the patient who's stable enough to have to entertain himself surfing the net on his phone than the one everybody's huddled around trying to stabilize. Sadly, many people, regardless of profession or lack thereof, are so self-centered that they can't comprehend the realities of the world whether it be in terms of health care, economics, or anything else. I have no problem taking care of other health care personnel and their family members in the PACU. Esp. people I know, as I believe I am able to do an excellent job of tailoring their care to their needs. Granted, this setting affords such a close ratio that it's easy to be perceived as caring and on-top-of-things if you're moderately competent or better. The patients/family members who're not any fun are people way out of their element who won't listen and don't realize how ignorant they are of perioperative patient management. This is worse in lesser trained assistive staff, and also some doctors who practice in totally irrelevant disciplines who probably have bad attitudes as a baseline. For example, I'll get the CNA/MA family member who is freaking out about one vital sign parameter that is consistent with the patient's status who won't listen when I explain why it's acceptable.
  3. Perpetual Student

    Not getting any patients assigned at end of preceptorship

    A student has no business taking an independent patient load in an ED nor any other sort of critical care area. While it's incredibly stupid that the facility does not provide access to the EMR to students, that shouldn't be the determinant of whether you take an independent patient load. It sounds like you're collaborating with your preceptor to pretty much do the entire job, which is what you should be doing as a student. Anything else would be doing you, and the patients, a disservice. It sounds like your preceptor respects you and is giving you a wonderful learning experience, which is what you're supposed to have. Would you really want to go to an ED and not have an RN be actively involved in your care, even if it's just to say behind the scenes "good work, I agree with your assessment and plan" to the student?
  4. Perpetual Student

    Overtime

    Specialized units with mandatory call often provide opportunity for OT (OR, PACU, IR, cath lab, and so on).
  5. Perpetual Student

    Giving iv meds through running line

    If the fluid is compatible with the drug I always just let it keep running (often turning up the rate if it's on gravity tubing to provide further dilution). When I am done pushing the drug I draw in some fluid from the bag to use to flush it. I definitely advise not unhooking the tubing. It wastes time and every time you do it you risk contamination. If the fluid and drug aren't compatible pause the fluid, flush, give the drug, and flush before resuming the fluid.
  6. Perpetual Student

    Overtime

    From staff perspective: the money can be nice; it's also better to have to work some OT occasionally than be so over-staffed that you have to take a ton of low census hours. For example, as a full time person I'd rather work 60 hours per week than 20. I prefer to not have to eat top ramen and drink cheap beer. From management perspective: ideally you would be able to staff properly to not need excessive OT, but there will always be circumstances in which you need someone (sick calls, vacations, and so on) when you would love to have as many options open to you as possible. Ideally you would find a volunteer rather than insisting someone work OT.
  7. Perpetual Student

    Yes, I'm in pain!

    Yeah, I would assuming they're complaining of significant pain or showing signs thereof. I'd give a smaller dose (perhaps 25 mcg of fentanyl) at increased intervals (10-15 minutes) until the patient reported relief or became too sedated. I would also be sure to give meds like ketorolac or acetaminophen. I'd coach in deep breathing to ensure adequate ventilation, of course. And would let the patient recover and be breathing adequately without coaching prior to transfer. To be clear, the quoted statement was with the immediate post-operative patient in mind who is still sedated due to agents other than opiods and who is being closely cared for in the PACU. Sometimes these patients end up with a protracted PACU stay, but I believe that's better than just saying "tough luck buddy" and shipping them to the floor with uncontrolled pain. I would certainly agree that in other contexts it would probably (but not always) be inappropriate to administer opiods to someone whose respiratory rate is 9.
  8. Perpetual Student

    Yes, I'm in pain!

    My mindset is to look for reasons to not give pain meds, not reasons to give them. Those reasons are rather exceptional--completely unresponsive, denies pain completely (even then I'll give something PO before transferring the patient and continue to reassess), respiratory rate less than 8 or otherwise completely inadequate such as with sleep apnea, maybe BP if it's really lousy but I'd just treat the pain then correct the BP most times. Otherwise, I consider it my job to give as much relief as possible without unduly compromising safety. I'd rather have a patient that's too sleepy than one that hurts too much. I can always let 'em wake up a touch prior to transfer if necessary. Some folks fail to consider how often the patient may be drowsy due to drugs such as benzos, antihistamines, or even lingering gas if it's shortly after arriving in the PACU, etc. yet have uncontrolled pain. As mentioned, you can look at the heart rate, but don't forget that it's just one piece of the puzzle. You might not see much of a bump in the beta-blocked patient, nor will the tachycardic patient necessarily be hurting. Also, in chronic pain there generally isn't much change in heart rate.
  9. Perpetual Student

    Medicating PONV vs. watchful waiting

    I prefer to be very aggressive re: PONV. I personally absolutely hate feeling that way, and figure most patients share that view.You also lose style points if your patient is puking all over the place post discharge from the PACU.I will give one antiemetic and see how the patient does, but if the nausea is severe I will typically give two very close together. If a patient gets nauseated just chilling in the bed, odds are it will recur if you don't give an antiemetic. Barring significant contraindication, I have a very low threshold for medicating for nausea. If the patient gives even the slightest indication of being nauseated I will medicate. Even if there is a contraindication for some antiemetics it's usually OK to give a different class. It is generally better to over-treat some than to under-treat. Particularly in patients that should not vomit due to risk for complication or exacerbated pain (e.g. neck surgery patients).I don't know if you ever do outpatients, but it is also important to be aggressive with that population. They need to be able to get up and move around some when it's time to go, hopefully without puking all over.
  10. Perpetual Student

    V-fib refractory to an initial/second shock

    Refractory to means not fixed by in that context. So if shocking your v-fib isn't working, what other intervention might you want to try? You're on the right track when you mention that it's a pharmacology question.
  11. Perpetual Student

    What makes nursing stressful for you?

    The possibility of forgetting to document something that will bite me on the butt makes me a bit uneasy. This job would be so much easier if there wasn't such a huge focus on CYA/make-some-regulatory-organization-happy documentation. Having to have an order for every stupid little anything that common sense should dictate. Having to not say what I really want to when dealing with stupid, lazy, and rude people.
  12. Perpetual Student

    IV narcotics?

    I would do it as above posters described in the situation at hand. Another way to do it is to draw up some NS from the flush into another 10 cc syringe, then draw up the appropriate amount of drug. That would be the correct way if you needed a precise concentration of drug in your syringe, for instance if you were going to titrate a medication to effect. Also, if the patient has a running IV I will open it wide open and just use a 3 cc syringe for the drug, drawing back from the bag to dilute it. That's a little more cost effective (and less work), plus when you're done you can just pull back again and push it in to flush it.
  13. Perpetual Student

    what are you going to do with this order?

    I'd fold it into an awesome paper airplane and then do my own homework. All kidding aside, what information would you like to have that you don't have? Is that information necessary to safely give the drug? Does your P&P manual provide the missing information? We can help you, but your learning experience will be more helpful if you work it out yourself. edited because the smiley didn't work. Also, compare the dosing information provided for the patient's weight. Do they match?
  14. Perpetual Student

    As a nurse, what does it mean to be in medicine?

    It annoys the heck out of me when someone calls nursing "medicine" or worse yet uses the phrase "medical field." It is misleading and disrespectful of nursing as its own discipline.
  15. Perpetual Student

    First Code Blue

    Call for help while assessing and start BLS, and other interventions once adequate assistance is on hand. Start CPR as promptly as possible. Don't be afraid to direct others in what to do to assist you. You need to be AGGRESSIVE. Learn to harness that adrenaline rather than letting it freeze you. Under extreme stress fine motor skills deteriorate. Try to use big, simple movements Most codes at work don't bother me all that much. If it's a younger person, or someone otherwise pretty healthy it sometimes makes me pretty sad. There's only one I've been involved in that still gives me chills every time I think about it. That's not to say I don't respect the value of life, just that I've grown to accept that everybody dies. And honestly, I wish the pain and suffering would end for some of the folks who're still kicking. Here's an excerpt from a post I made in response to a somewhat similar thread in January:
  16. Perpetual Student

    When is it too late to intiate CPR?

    The only real problem in the post I see is where the above was used as part of the rationale for not starting CPR. Those are indications to perform CPR, not withhold it! That said, you've received some good advice here.